Abstract
The pathogenesis of gastroesophageal reflux disease (GERD) is complex and involves changes in reflux exposure, epithelial resistance, and visceral sensitivity. The gastric refluxate is a noxious material that injures the esophagus and elicits symptoms. Esophageal exposure to gastric refluxate is the primary determinant of disease severity. This exposure arises via compromise of the anti-reflux barrier and reduced ability of the esophagus to clear and buffer the refluxate, leading to reflux disease. However, complications and symptoms also occur in the context of normal reflux burden, when there is either poor epithelial resistance or increased visceral sensitivity. Reflux therefore develops via alterations in the balance of aggressive and defensive forces.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 277-288 |
| Number of pages | 12 |
| Journal | Gastroenterology |
| Volume | 154 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 2018 |
Funding
Conflicts of interest The authors disclose the following: Jan Tack has provided scientific advice to Abide Therapeutics, Alfa Wassermann, Allergan, Chr. Hansen, Danone, Genfit, Ironwood, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Nutricia, Ono Pharma, Rhythm, Shionogi, Shire, SK Life Science, Takeda, Theravance Biopharma, Tsumura, Yuhan, Zealand, and Zeria; has received research grants or support from Abide Therapeutics, Shire, and Zeria; and has served on speakers’ bureaus for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, and Zeria. John Pandolfino is a speaker for Astra Zeneca and Takeda, a speaker and consultant for Medtronic, Sandhill, and Torax, and a consultant for Impleo, and has stock options in Gastrodyne.
Keywords
- Acid Exposure
- Esophageal Motility
- Esophageal Sensitivity
- Hiatal Hernia
- Transient Lower Esophageal Sphincter Relaxations
ASJC Scopus subject areas
- Hepatology
- Gastroenterology